Provider Demographics
NPI:1255791950
Name:GWANGIS CONSELING
Entity type:Organization
Organization Name:GWANGIS CONSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHS
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-287-2187
Mailing Address - Street 1:308 TURTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3824
Mailing Address - Country:US
Mailing Address - Phone:985-287-2187
Mailing Address - Fax:
Practice Address - Street 1:308 TURTLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3824
Practice Address - Country:US
Practice Address - Phone:985-287-2187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWANGIS CONSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization